Telemedicine Changes Delivery Of Health Services

Nebraska Medical in Omaha, Neb., used cameras for one-on-one monitoring of high-risk patients.

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Advances in medical imaging technology, including cameras, lights, processing units and networks, are pushing the envelope of what can be delivered in a health care setting.

It’s a scene ripped from science fiction: A robot buzzes up to a hospital bed, does a cheerful Q&A with the patient, checks the medical history and orders additional therapy before ambling off to finish morning rounds.

This is not a sequel to the Short Circuit robot-comedy movies of the 1980s, but a modern hospital using the RP-VITA, a self-navigating robot that allows a real doctor to see patients. The coolest thing about the RP-VITA is the huge front mounted video screen that displays a near life-sized, live image of the doctor, who can also see the patient through a pair of robotic eyes: front-mounted video cameras.

RP-VITA (vita is Latin for ‘life’) was created by InTouch Health and iRobot, and bears a passing resemblance to Johnny 5, the good-natured star of the Short Circuit films. (Editor’s note: I, Robot is the famous title of a collection of science fiction short stories by scientist, educator and author Isaac Asimov.)

The RP-VITA doesn’t do comedy shtick like its fictional counterpart, but is quite impressive nonetheless. Approved by the FDA last year, it has been adopted by about 60 hospitals and makes it possible for doctors to have doctor-to-patient consults without actually being in the same room as the patient.

“We believe it’s a game-changer,” said Michael Chan, InTouch Health general manager and executive vice president for marketing. “What we have are a couple of challenges―the population is aging and the need for quality care is increasing.”

The device, which is about as tall as the average adult, marries enhanced navigation that allows it to “see” people and objects with a state-of-the-art telemedicine system. About 1,000 hospital locations around the world participate in InTouch’s telemedicine network, Chan said.

Robotic care, as well as telemedicine, makes it easier for patients who are frail or live in remote locations to see a high-quality specialist.

“Remote presence allows equity in access for these types of patients at a much lower cost of delivery,” Chan said. “And we see substantial gains in patient outcomes.”

Nowhere is telemedicine more needed than in the Department of Veterans Affairs health care system, which treats wounded soldiers who frequently return home with multiple injuries and complex diseases, said Adam Darkins, chief consultant of VA care coordination/telehealth services. The VA treated more than a half-million patients through telemedicine last year and expects the numbers to continue to grow, said Darkins, a neurosurgeon.

Often, wounded veterans are not close to the specialists they need, he said.

“Ill health and mishaps have no respect for geography and take place in locations where the specialists are not,” Darkins said. “Telemedicine helps to ensure that the right care happens in the right place at the right time.

BETTER INSIDE PICTURES

Advances in medical imaging technology, including cameras, lights, processing units and networks, are pushing the envelope of what can be delivered in a health care setting. Some of the most dramatic innovations have come in the operating room where doctors can perform minimally invasive surgery using a video laparoscope with a miniature camera built into its tip. Laparoscopic surgery, performed through a series of tiny incisions, vastly reduces recovery time. About 2.8 million such procedures were performed last year.

Electronics maker Olympus has developed the world’s only 3D articulating laparoscope, the Endoeye Flex 3D. It provides 3D high-definition images that help restore the surgeon’s natural 3D vision and depth perception.

The articulating-tip makes it possible to view anatomy and see critical areas not previously accessible with standard rigid laparoscopes. The benefit for the surgeon is better sight lines and the ability to peer around anatomical structures to perform more precise grasping, dissection and suturing, when compared to 2D imaging systems.

“The Olympus HD 3D System brings value to those surgeons that need the precision, resolution, and depth perception of 3D without the substantial capital investment and annual maintenance expenses associated with alternatives,” said Luke Calcraft, president of the medical systems group at Olympus Corporation of the Americas.

Schott video imaging bundle

The company also just launched the next-generation BF-P190 and BF-XP190 bronchoscopes for peripheral and small anatomy bronchoscopy. Flexible bronchoscopy is widely used in the diagnosis of respiratory pathologies, and Olympus’ new devices provide better imaging in an ultra-slim package. The new bronchoscopes are powered by a high-tech mini CCD that provides improved image quality compared to previous models.

Eye or ophthalmologic surgery is another area that has benefited from the surge in camera design. Sony’s medical systems division just released a flexible high-definition camera: the MCC-500MD. The camera’s high-quality sensor lets physicians freeze sharp images with no pixilation.

The MCC-550MD camera has enough output flexibility to fit a range of medical environments, with HDMI, HD-SDI (1080p), S-video and composite connectivity. The camera can run on AC power, and its video sync capability allows easy use in 3D configurations.

“This new camera’s HD quality and image reproduction capabilities are perfect for capturing high resolution video and still images for ophthalmology procedures,” said Julie Holodak, senior marketing manager for Sony’s medical systems division. “Its color performance rivals that of more expensive three-chip cameras and gives medical operations of any size a high-performance tool at a very affordable price.”

Ximea CB200 imaging module

Ximea, a Germany-based scientific-grade camera manufacturer, is to soon release two new scientific lines of cameras: the xiB CMOS camera with 12- and 20-megapixel resolutions, and the xiD line of scientific CCD cameras with resolutions up to 12 megapixels and a USB3 interface, said Ivan Klimkovic of Ximea’s international sales department. Both camera lines use special architectures to improve camera speed and transfer rates.

MORE LIGHT

Optics and lighting producers are helping rewrite the script for the medical application of video devices.

Improved imagery applications are not confined to the hospital operating room. Institutions are using network cameras to care for high-risk patients and as teaching tools. The Nebraska Medical Center used high-tech IP cameras to replace one-on-one physical monitoring of at-risk patients, said Bruce Doneff, a spokesman for IQinVision/Vicon, which produces video management software and network cameras.

At the NMC, one-on-one, 24/7 care was standard practice for patients who, for example, were on suicide watch, prone to violent outbursts or in a critical state of health. Administrators searched for a cheaper solution and deployed nearly 300 IQeye HD megapixel cameras linked to a dozen monitoring stations located throughout the facilities. Each station allows technicians to observe multiple patients simultaneously. The day/night vandal-proof IP dome cameras provide staff with clear real-time video at 30 fps with a 720p resolution, and the unobtrusive style blends into the hospital’s visual design.

Many institutions combine teaching with health care services. Axis, a Sweden-based company that produces network video products, provided a camera-based solution for the University of Wisconsin-River Falls when the university looked to expand its video system.

UWRF needed a system to record patient therapy sessions and allow instructors to remotely observe students during these sessions. The system Axis installed also allowed instructors to easily retrieve video of specific disorders or intervention techniques to use later as examples of actual therapy sessions in their classrooms. The department chose fixed 1080p/3MP Axis P1346 network cameras with two-way audio for its adult therapy rooms.

Another Axis customer, CentraCare Health System, a central Minnesota healthcare collaborative, used HDTV-quality Axis P1214-E network cameras to improve patient care, strengthen security and fortify narcotic storage at its facility. Covert cameras were used to verify identities of people opening prescription narcotics locker, and cameras were also used in rooms of high-risk patients for 24/7 security.

INTO THE FUTURE

Experts believe that the future of robotic care and telemedicine is boundless. If a robot can manage in the chaotic environment of a busy hospital, they can thrive anywhere, said Colin Angle, chairman and CEO of iRobot.

“There are very few environments as difficult to maneuver as that of a busy ICU or emergency department,” Angle said. “Having crossed this technology threshold, the potential for self-navigating robots in other markets, and for new applications, is virtually limitless.”